Healthcare Provider Details

I. General information

NPI: 1609617091
Provider Name (Legal Business Name): SOLOMONS MIND & EYES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2024
Last Update Date: 06/01/2024
Certification Date: 06/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2185 E CENTURY BLVD APT 105
LOS ANGELES CA
90002-4019
US

IV. Provider business mailing address

2185 E CENTURY BLVD APT 105
LOS ANGELES CA
90002-4019
US

V. Phone/Fax

Practice location:
  • Phone: 318-482-4521
  • Fax:
Mailing address:
  • Phone: 318-482-4521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: CASSANDRA GAYE CLAIBORNE
Title or Position: OWNER
Credential: DRIVER
Phone: 318-482-4521